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Mental illness is highly common in the United States. Data presented from the 2020 National Survey on Drug Use and Health (NSDUH) found that twenty-one percent of all U.S. adults, which is equal to an estimated 52.9 million adults aged eighteen or older, in America live with AMI (any mental illness). Of the nearly one in five adults with AMI, 24.3 million (46.2%) received mental health services in the past year. Due to the Affordable Care Act, medical insurance companies are obliged to cover mental health services. Individuals diagnosed with a mental health illness can seek DBT therapy and depending on the specifics of their health insurance plan, may be eligible for covered services. However, it is important to note that not all DBT providers accept insurance as a form of payment.

There is an overabundance of health insurance companies available in America, and within each company, a myriad of different (often tiered) healthcare coverage plans are offered. Each plan has extremely specific details surrounding the exact types of medical and mental health services that will be considered eligible, which indicate what services will be covered under the plan. Each plan will have a different monthly premium fee, and in many cases, if a monthly premium payment is missed the plan is terminated. Some plans cover a portion of fees associated with obtaining services from an out-of-network provider, and some do not. Each plan has different co-payment fees for different services (e.g., filling a prescription, a specialist visit, surgery, a primary care visit, etc.). Insurance is complicated, and insurance companies change the fine printed information yearly. The out-of-pocket responsibility for DBT will be dependent upon one’s health insurance plan and the mental health provider selected. Prior to the rendering of any type of mental health services, it is best to verify with the provider that they are in-network and accept your plan.

Affordable Care Act Basics

In 2010, President Obama signed the ACA (Affordable Care Act) into federal law. The purpose for signing the ACA into law was threefold: to create affordable health insurance coverage, enabling more individuals to obtain healthcare; to expand the Medicaid program, and to support “innovative medical care delivery methods designed to lower the cost of health care generally.” Prior to the passing of this law, insurance companies were not obligated to cover pre-existing conditions (e.g., eating disorders, substance use disorder, etc.). The ACA requires all health insurance plans to provide coverage for pre-existing conditions. Furthermore, the ACA stipulates that health insurance companies are obligated to provide similar coverage for the treatment of all diagnosable mental illnesses. 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

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